Link Between Menopause And Heart Disease

While women at any age may be at risk for heart disease, some risk factors for heart disease increase around the time women experience menopause, usually between age 51 and 54.

“Menopause doesn't cause heart disease, but it's a time of life when women should take stock of their cardiovascular health,” said Polly Moore, MD, FACC, a cardiologist with Franciscan Physician Network Indiana Heart Physicians in Indianapolis. “In fact, a woman’s risk of having a heart attack before menopause is much lower than a man’s at the same age. But 10 years after menopause, the number of women having heart attacks rises significantly.”

Key Takeaways: Menopause & Your Heart

• Menopause doesn't cause heart disease, but it can raise your risk. A woman's risk of having a heart attack before menopause is much lower than a man's at the same age, but 10 years after menopause, the number of women having heart attacks rises significantly. 
• Estrogen loss affects blood vessels and other risk factors.
• Proactive steps include a healthy diet, regular exercise and talking with your doctor about your family health history and your heart disease risks.

Can Estrogen Levels Cause Heart Problems?

Experts believe estrogen, a hormone that declines over menopause, has a positive effect on blood vessels, keeping their inner linings flexible. As estrogen levels wane, the blood vessels are impacted.

In fact, studies show that women who experience early menopause naturally, or have had their ovaries removed before age 40, were shown to be at a higher risk for heart disease.

After menopause, other changes occur in many women, including a rise in blood pressure and cholesterol and triglyceride levels.

Do Menopause Symptoms Affect Your Heart?

New research suggests that women with both migraines and vasomotor symptoms (hot flashes and night sweats) are significantly more likely to develop heart disease or have a stroke.

Published online Feb. 14 in the journal Menopause, the study found that women with a history of both symptoms were 1.5 times as likely to develop heart disease and 1.7 times as likely to have a stroke when compared to other women. The link was particularly strong among women who have migraines with aura.

The study, which followed women ages 18 to 30 into their early 60s, included nearly 2,000 women. 

Nearly 8 in 10 menopausal women experience hot flashes, while migraines affect about 17.5% of women in their late reproductive years, the Menopause Society said.

The study was described as the first to examine the joint influences of migraine and hot flashes/night sweats independent of estrogen use and traditional risk factors for heart disease, such as tobacco use, cholesterol levels, blood pressure and fasting blood sugar levels.

Does HRT Help Your Heart?

So is estrogen replacement the answer to heart concerns after menopause? Not really, said Dr. Moore.

“While hormone replacement therapy can help some women manage their menopausal symptoms for a few years, there’s really no evidence that it helps lower your risk of cardiovascular disease,” she said. “Plus, hormone replacement therapy does have its risks, such as blood clots and stroke.”

How Can I Protect My Heart During Menopause?

The best defense against heart disease is a good offense, no matter your age. If you eat a healthy diet, exercise regularly, maintain a healthy weight and don’t smoke before you hit menopause, you’ll be better prepared to age gracefully through “the change.”

But there are many ways you can be proactive in your post-menopausal heart health.

"My advice for most women to improve heart health would be to stay active, make sure you pursue a healthy diet, especially when you're postmenopausal," said Franciscan Physician Network cardiologist George Lolay, MD, "and the more you control your risk factors, the lower likelihood of you having heart a problem in the future.

Talk To Your Doctor About Your Numbers

Discuss your blood pressure, cholesterol and triglyceride levels with your doctor and ways to manage them better, whether through lifestyle changes or medications. Talk about weight and ask for help in setting a weight loss goal.

Learn More About Your Family Health History

Our risk for a heart attack lies, in large part, in our genes, so let your doctor know if any immediate relatives have had high blood pressure, heart attack, heart surgery or stroke.

Stop Smoking

Smoking affects a woman's risk of heart disease even more significantly than it does a man's. Discuss quitting options with your doctor.

Manage Your Diabetes

Because it affects the blood circulation over time, diabetes increases your risk of heart disease.

Eat A Low-Fat, High-Fiber Diet 

Make diet changes slowly if you need to by including more vegetables into your diet, cutting back or eliminating red meat and limiting the amount of processed foods you eat.

Get Active

Regular exercise can help you manage your weight, raise good cholesterol and lower triglycerides. Thirty minutes for five days a week is a good place to start. 

“Make conscientious choices today for your future self and for your family,” said Dr. Moore.

What Are Women's Signs Of A Heart Attack?

Many times, signs of heart attack are different for women. Instead of intense chest pain, they may feel something more like chest pressure or discomfort. Other common signs of a heart attack are unusual fatigue, shortness of breath, pain in the back, neck, arm or jaw, dizziness or nausea.

Frequently Asked Questions: Menopause And Heart Disease

Does early menopause affect the heart?

"Early menopause are highly associated with a higher risk of coronary disease, stroke, and heart failure," said Stephen Cook, MD, a cardiologist with Franciscan Health Indianapolis. "The mechanisms driving for these risks are deficiencies in endogenous hormones. 

"We know that the incidence of ischemic heart disease does start to increase after menopause. We believe that, again, this decline in our estrogen levels are somewhat implicated, but there may be some unfavorable ratio of just sex hormones overall between testosterone and estrogen that may contribute to this."

How does menopause affect blood pressure?

"As women begin to transition into their menopausal years, that blood pressure continues to elevate," Dr. Cook said. "The reason why blood pressure may continue to elevate is that it is the declining of estrogen levels, which also leads to upregulation of another hormone in our body known as the renin-angiotensin system, which tightly regulates and controls blood pressure. When these hormones get upregulated, this further constricts our blood vessels and also makes women more salt-sensitive, so thus increasing our likelihood of becoming more hypertensive or developing high blood pressure."

Does menopause impact cholesterol levels?

"People may not know women's cholesterol profiles tend to look a little bit better than men's," said Reece Clark, MD, a board-certified OBGYN practicing at Franciscan Health Mooresville. "Their HDL good cholesterol tends to run a little bit higher and part of that is because of the effects of estrogen and progesterone. So after you lose that, after menopause, you could expect that your cholesterol profile's going to get a little bit worse, and then that can contribute to heart disease."

How common is heart disease in women?

"Half of the 27 million Americans living with cardiovascular disease are women, but yet it remains underdiagnosed, undertreated, and often portends worse outcomes in women compared to men," Dr. Cook said.